Relationship of Distance to PCI Center With In-Hospital Mortality After STEMI: Insights From a Rural Regional STEMI
Raihan Kabir1, Jennifer Liao2, Andres Cordova Sanchez1
1Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont.
Insights
Travel distance to percutaneous coronary intervention (PCI) centers did not impact ST-elevation myocardial infarction (STEMI) mortality in Northern New England. Regional STEMI referral networks ensure consistent outcomes regardless of patient travel distance.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Patients with ST-elevation myocardial infarction (STEMI) presenting to hospitals without primary percutaneous coronary intervention (PPCI) capabilities face treatment decisions.
- Treatment options include transfer for PPCI or fibrinolytic therapy, influenced by the time to treatment.
- The impact of travel distance to PCI centers on STEMI outcomes in rural settings is a critical consideration.
Purpose of the Study:
- To investigate the association between residential distance to PCI centers and in-hospital mortality among STEMI patients in a rural healthcare system.
- To evaluate if travel distance influences treatment strategies and outcomes in STEMI care.
Main Methods:
- Retrospective analysis of 6225 STEMI patients from the Northern New England Cardiovascular Disease Study Group registry (2018-2023).
- Calculation of residential travel distance to PCI centers using ZIP Code centroids, categorized into quartiles.
- Assessment of in-hospital mortality using multivariable logistic regression, considering treatment strategies: initial PCI, transfer for PPCI, or pharmacoinvasive PCI.
Main Results:
- The median residential distance to a PCI center was 38.2 miles.
- Patients were treated via initial PCI (44.4%), interhospital transfer for PPCI (23.8%), or pharmacoinvasive PCI (31.9%), with increasing median travel distances for transferred groups.
- No significant association was found between residential distance to PCI hospitals and adjusted in-hospital mortality for STEMI patients across all treatment groups.
Conclusions:
- In the Northern New England region, established STEMI referral networks mitigate the impact of travel distance on patient mortality.
- Despite substantial travel distances for some patients, outcomes for STEMI were not adversely affected by proximity to PCI centers.
- These findings support the effectiveness of current regional STEMI care models in ensuring equitable outcomes.
Background:
Patients who present with ST-elevation myocardial infarction (STEMI) to a hospital without primary percutaneous coronary intervention (PPCI) capability may be transferred for PPCI or receive fibrinolytic therapy, depending on whether the first medical contact to balloon time of ≤120 minutes can be achieved. We hypothesized that travel distance to the percutaneous coronary intervention (PCI) center might impact STEMI outcomes in a rural STEMI system of care.
Methods:
We retrospectively analyzed 6225 consecutive STEMI patients from the Northern New England Cardiovascular Disease Study Group registry from 2018 to 2023. Residential distance to care was calculated by road travel distance between ZIP Code centroids and grouped into quartiles. Patients were categorized by treatment strategy: initial presentation to a PCI center, transfer for PPCI, or pharmacoinvasive PCI. The primary outcome was in-hospital mortality. Multivariable logistic regression evaluated the association between residential distance and treatment strategy with in-hospital mortality.
Results:
The median residential distance to PCI center for STEMI patients in Northern New England was 38.2 miles (IQR, 47.1). Of the overall cohort, 44.4% (median travel distance: 17.2 miles) had index presentation to a PCI hospital, 23.8% (median travel distance: 40.1 miles) underwent interhospital transfer for primary PCI, and 31.9% (median travel distance: 66.5 miles) were transferred for pharmacoinvasive PCI after initial lytic therapy. There was no association between distance to PCI hospital and adjusted in-hospital mortality after STEMI, irrespective of the treatment group.
Conclusions:
In Northern New England with contemporary regional STEMI referral networks, distance to PCI hospital did not impact STEMI mortality despite substantial travel distances for many patients.
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